LEILA ANDERSON
Subscriber on policy B04M000004
Claims
1
Attributed to this person
Charged
900.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
585.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | LEILA ANDERSON |
| Role on the policy | Subscriber |
| Policy | B04M000004 |
| Date of birth | 17 Oct 1997 |
| Plan | SILVER HMO |
| Covered from | 28 Apr 2025 |
| Covered to | 6 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 585.00 |
| Total | 585.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000013 | 26 Apr 2025 | 900.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |